Spinal decompression explained
The phrase “spinal decompression” refers to a variety of surgical techniques used to treat painful compressed or pinched spinal nerves (neural impingement). The spinal canal and the spinal nerve apertures can become irritated when they become too small due to bulging or collapsed discs, enlarged joints, loosened ligaments, and bony growths. Leg discomfort is caused by compression on the spinal nerve roots.
The following ailments are typically treated using spinal decompression surgery:
- Spinal stenosis is a narrowing of the spinal column that places pressure on the surrounding nerves.
- Sciatica is a condition in which a damaged spinal disc impinges on a nerve below the disc.
- Spinal injuries, including fractures and tissue edema
- As cancer spreads from one area of the body, such as the lungs, it can push on the spinal cord or nerves and cause metastatic spinal cord compression.
Summary of the Spine
The spine is made up of 33 tiny bones called vertebrae that are stacked one on top of the other and are separated by a soft intervertebral disc. The nucleus pulposus, a soft jelly-like material found in the core of the intervertebral disc, is surrounded by many collagenous layers known as the annulus fibrosus like an onion. This disc connects, aids in movement between vertebrae, and also serves as the spine’s shock absorber. Hence, the vertebrae serve as a shield to protect the spinal cord and nerve roots.
Who Should Have a Spinal Decompression Operation?
Patients with spinal stenosis are advised to have spinal decompression surgery. Narrowing of the spinal canal, or spinal stenosis, is a disorder that can result in persistent discomfort, numbness, and muscular weakness in the arms or legs. This disorder primarily affects the elderly and is brought on by degenerative changes that cause the ligaments to thicken and the facet joints to expand.
The following conditions are advised for someone who needs spinal decompression surgery:
- Leg or foot ache, numbness, weakness, or pins and needles
- Back discomfort that is worse in the legs
- Not responding to any form of medicine or physical treatment
- Causes difficulties standing or walking, which can have an impact on one’s quality of life.
- In a small percentage of instances, strain on the bladder might cause paralysis or issues with bowel or bladder function.
Procedure for Spinal Decompression
There are numerous different types of surgical procedures that are frequently used to relieve the symptoms of nerve decompression:
- Microdiscectomy Micro decompression: This procedure is typically used to treat Sciatica, a lumbar herniated disc that causes leg discomfort. The surgery entails employing microsurgical methods to remove a portion of the disc that is pushing on the nerve.
- Lumbar Laminectomy: Leg discomfort brought on by lumbar spinal stenosis is often treated with a lumbar laminectomy with open decompression. The goal of this treatment is to completely decompress the spinal canal’s left and right sides by removing the bony roof lamina and any thickened ligaments that were covering it.
- Laminotomy: This procedure includes removing a tiny section of the laminar roof and ligaments that are present above the spinal canal, leaving the bulk of the lamina intact. It can be used to decompress either the left or right side of the spinal canal. By using this technique, the lamina’s natural support is preserved, reducing the possibility of postoperative spinal instability. Occasionally, an endoscope may be employed, allowing for a more minimally invasive incision.
Depending on the severity and needs of the situation, each of these operations can be carried out separately or in combination.
Prior to the process
- Before the procedure, many diagnostics are done, such as blood tests, electrocardiograms, and chest X-rays.
- The medical history of the patient, including any allergies, medications and vitamin intake, past operations, history of bleeding, and anaesthetic responses, is recorded.
- One week before surgery, the patient is recommended to cease using any non-steroidal anti-inflammatory drugs (NSAIDS) and blood thinners (such as Coumadin and aspirin).
- Also, the patient is instructed to quit smoking, chewing tobacco, and drinking alcohol one week before and two weeks after the procedure because these activities might lead to bleeding issues.
On the day of the operation, the patient is admitted to the hospital. Also, it is suggested to avoid eating or drinking after midnight the night before surgery. In the arm, an intravenous line is inserted.
Throughout the process
Depending on the intricacy, general anaesthesia is used during surgery, and the total process might last anywhere between one and three hours.
- The patient is ready for the procedure.
- A cut is made across the relevant vertebra around the centre of the back.
- To reveal the lamina of each vertebra, the back muscles are divided down the centre and then pulled to either side.
- An X-ray of the exposed bone is obtained to identify the proper vertebrae, and then the desired procedure—laminectomy or laminotomy—is carried out.
- Decompress the spinal nerve: Foraminotomy is a technique in which the facet joints, which are located directly above the nerve roots, are cut or trimmed to make more room for the nerve roots. The neural foramen where the spinal nerves leave the spinal canal will become larger as a result. A discectomy is done if a herniated disc is the source of the compression.
- Closure: Sutures or staples are used to sew up muscle and skin wounds.
After the operation
Depending on the surgery, the patient will spend four or five days in the hospital. The patient will continue to take painkillers to ease their postoperative discomfort. After the procedure, the patient will be able to sip on fluids before gradually transitioning to a complete meal. After the operation, the patient can shower 4-5 days later.
Over the first few weeks, the patient might need assistance with basic everyday tasks like getting dressed and taking a shower. Following the operation, fatigue is typical. One can gradually resume their regular activities.
Following hospitalisation
Following the procedure, the patient should adhere to the following restrictions:
- The patient is recommended not to drive for two to four weeks following surgery or until the doctor gives him the all-clear.
- Should not spend extended periods of time sitting.
- Should not bend or twist at the waist or lift anything heavy.
- After the initial follow-up appointment, the patient is free to perform any housekeeping and yard work. This covers tasks like mopping, vacuuming, ironing, loading and unloading the dishwasher, washing and drying clothing, and gardening.
- The patient is told to stop smoking. Smoking slows the healing process by raising the possibility of problems like infections and preventing bone fusion.
- The patient is told to stroll. One should initially begin with a little distance and then gradually expand the distance.
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Hazards of Spinal Decompression
The risks connected with spinal decompression surgery are as follows:
- Infection
- Bleeding
- Damage to the nerves or tissues, or enduring agony
- Paralysis
- Sensitivity to anaesthesia
- Damage to the soft tissue nearby
- Thrombus in the deep veins (DVT)
- Vertebrae that don’t fuse
- Migration of the bone graft: Shortly following surgery, the bone graft may shift from its ideal location in the space between the vertebrae.
- Cerebrospinal fluid leakage (CSF)
